Prostate cancer survivors make up the largest group, 41 percent, of male cancer survivors. In these survivors, early detection of recurrence can lead to life-saving interventions, but in older men who survived low-risk cancer and have limited life expectancy, those same interventions may do more harm than good.
However, when UC San Francisco researchers analyzed current monitoring practices, they found that doctors use a one-size-fits-all approach to monitoring – performing the same frequency of testing regardless of a survivor’s health and prognosis. In a new study, the researchers recommend that doctors individually tailor how often older prostate cancer survivors who have undergone curative treatment are monitored for disease recurrence.
The study is online Feb. 8, 2018, in the Journal of General Internal Medicine.
This is the first study suggesting a need for guidelines to encourage prostate-specific antigen (PSA) monitoring that considers life expectancy, risk of recurrence, and the values and preferences of cancer survivors rather than a one-size-fits-all approach, said senior author Louise Walter, MD, chief of the UCSF Division of Geriatrics and geriatrician at the affiliated San Francisco VA Health Care System.
After surgery or radiation, some data suggest the interventions given just after early detection of recurrence based on elevated PSA levels may improve survival. But PSA monitoring may lead to complications from invasive diagnostics or treatment and may even be unnecessary in older men with a history of low-risk cancer or limited life expectancy.
In the study, Walter and her colleagues examined the national VA and Medicare data of 13,397 men age 65 or older diagnosed with prostate cancer between Jan. 1, 2003, and Dec. 31, 2008, and treated with radiation or radical prostatectomy. All participants were followed for four years after their one-year treatment anniversary date.